Provider Demographics
NPI:1538949755
Name:ZIMMERMAN FAMILY DENTISTRY ACQUISITION, PLLC
Entity type:Organization
Organization Name:ZIMMERMAN FAMILY DENTISTRY ACQUISITION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-863-5171
Mailing Address - Street 1:1213 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2475
Mailing Address - Country:US
Mailing Address - Phone:228-863-5171
Mailing Address - Fax:228-863-5233
Practice Address - Street 1:1213 BROAD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2475
Practice Address - Country:US
Practice Address - Phone:228-863-5171
Practice Address - Fax:228-863-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental